Building Capacity to Design, Implement and Evaluate Participatory Action Research Projects to Decrease the Burden of HIV and Promote and Protect the Health and Safety of the Healthcare Workforce: A South African-Canadian Collaboration L Nophale 5, A. Yassi 2, M. Engelbrecht 1, A. Liautaud 2, L. O’Hara 2, A. Rau 1, E. Bryce 3, M. Zungu 4, D. Roscoe 3 J. Spiegel 2, K. Uebel 1, A J van Rensburg 1 AFRI-CAN FORUM, LAICO LAKE VICTORIA HOTEL, ENTEBBE JANUARY Centre for Health Systems Research & Development, University of the Free State 2 Global Health Research Programme, University of British Columbia 3 Vancouver Coastal Health, Vancouver, Canada 4 National Institute for Occupational Health, Johannesburg, South Africa 5 Occupational Health Unit, Department of Community Health, Bloemfontein, South Africa 18 January 2013

Overview Given the high incidence of HIV/TB in South Africa, building occupational health and infection control knowledge and skills is a priority. With the need for more research – building “research receptor capacity” is also crucial. 1-year certificate programme: training to conduct and evaluate workplace-based HIV/TB prevention interventions. The 31 participants were grouped into eight groups and assigned South African and Canadian mentors. TB and HIV/AIDS modules developed for an existing health information system (OHASIS). An evaluation was conducted at each phase of the programme – lessons are shared.

Why Focus on Healthcare Workers? There is a critical shortage of HCWs globally, especially in Africa. The HIV/TB epidemics have put enormous strain on HCWs causing stress and burnout. HCWs are at high risk for TB exposure, BUT are under- researched. Poor infection control measures. HCWs with HIV/TB are not obtaining the access to the HIV/TB services they need. Source: WHO World Health Report 2006

Certificate Programme Curriculum Module 1: Introduction to key concepts. Mid‐term period 1: Participants formed 8 groups and identified topics for their research projects. Module 2: Groups presented project objectives and design. Mid‐term period 2: Groups finalised project planning. Module 3: Groups finalised and practiced their presentations. Post‐programme activities (May 2012 ‐ August 2012): Further training and assistance to programme participants Presentation of research findings and graduation ceremony: Groups presented findings to 100 delegates 28/31 graduated

Programme Evaluation: Methods Quantitative and qualitative methods. Six intervals of questionnaire administration assessed self‐rated: knowledge, comfort with skills, attitudes. Actual knowledge assessed using true/false questions. Reactions assessed using open‐ended questions. Three sets of face-to-face individual interviews were conducted, mid‐way through the programme with each participant, and with both mentors and participants after the programme’s conclusion.

Programme Evaluation: Description Of Participants Occupations Nurses: different wards in district, regional and specialist hospitals. Health managers: Free State Department of Health, Xhariep District, Mangaung local municipality. Health researchers: University of the Free State. Sex of respondents 26 (83.9%) female 5 (16.1%) male

Programme Evaluation: Quantitative Results Sig difference was found between baseline and post- programme in self-rated knowledge (9.16% increase; p=0.49). Sig difference was found in comfort with skills (17.90% increase; p=0.001). Self‐rated knowledge improvements corroborated by actual knowledge increases (increase from 68.5% to 75.57%; p=0.156). Self‐rated attitudes scores were very high at the onset (92.5 %; SD: 9.84%); did not significantly change. Median score for research-related skills remained 60.0%.

Programme Evaluation: Qualitative Findings (1) Many participants provided examples of changes made in their workplace as a result of the programme: improved infection control practices, increased and appropriate use of PPE and reshuffling of vulnerable employees to safer posts. reported feeling “empowered” and more self‐assured in their jobs; they are now leaders in workplace HIV and TB prevention.

Programme Evaluation: Qualitative Findings (2) Interviews revealed some challenges and weaknesses: Mentors: initial low levels of research knowledge among participants was a barrier in allowing them to fully grasp and utilise more advanced skills. The programme was labour intensive - difficult to sustain in the South African context without many mentors, and further Canadian involvement and financial support.

Programme Evaluation: Group Projects Participants reported the group research projects were “eye‐opening” and that they are no longer “intimidated” by the research process. Most groups made recommendations to management. Several workplace changes have already been made as a direct result of project findings.

Strengths and Challenges * Collaboration and trust built facilitated implementation of a 5- year CIHR-funded research programme to study best practices in addressing HIV and TB workplace needs. StrengthsChallenges Participants were empowered in research and OHSParticipants were inexperienced, lacked research skills Problems were identified and solutions implementedDifficulties implementing projects Relationship building – UBC, UFS, FSDoH, NIOH, ILOIntensive guidance and support necessary Training strengthened OHASISLack of computer and internet skills and access

Lessons Learned and Recommendations Overall, the programme was a success. Similar programmes may consider setting entry requirements to ensure adequate baseline skill levels. International collaborations and partnerships are effective ways to generate solutions and catalyse action to decrease occupational exposures among HCWs.

Acknowledgements Special thanks to all the Certificate Programme participants and mentors. The Free State Department of Health for authorising and supporting the project This work was carried out with support from the Global Health Research Initiative (GHRI), a research funding partnership composed of the Canadian Institutes of Health Research, the Canadian International Development Agency (CIDA), and the International Development Research Centre. This work was carried out with the aid of a grant from the International Development Research Centre (IDRC), Ottawa, Canada, and with the financial support of the Government of Canada provided through the Canadian International Development Agency (CIDA)

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